Children's photo release form

For Children under the Age of 18:

As a parent/guardian of  (child’s name), I give my permission for Mount Pleasant Christian Church to use the photo/video as described below for future promotional purposes.

Brief description of photo/video used:

Event:  2009 Christmas Program  Date: 2009, Dec 12-13

Photographer’s name: MPCC Worship & Arts Department

Photographer’s phone number:  317-881-6727

Parent Signature: 

Date:     Phone number:

Address:   

Email Address:  (requried)